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FCR OFFICE USE: APPLICATION FOR SANITATION PERMIT ` .?1. -------------------- (Complete in Triplicate) Permit No. This Permit Expires 1 Year From Date Issued Date Issued _ -------------------------- ------------- -------------- Application is hereby made to the San Joaquin Local Health District for a permit to construct and install the work herein described. This application is made in compliance with County Ordinance No. 549 and existing Rules and Regulations: 'yf�C .. JOB ADDRESS�LOCATION /7. 1_ `J�'------------ CENSUS TRACT Owner's Name � �' --------------------------------Phone ��- �.... --------- y Address -------------------------- City --------------- ---------•-•------- --------------------=------- c Contractor's Name ---- - --------- -- - --- - - 1� _- --- -'---License #�Cf�. ��------ Phone Installation will serve: Residence E]Apartment House[]•.Commercial-.].railer Court i ;. Motel F1 Other -------------------------------------------- i Number of living units:__________ Number of bedrooms ___________Garbage Grinder .--_ ____ Lot Size ____________________ " ,4. L'3 Water Supply: Public System and: --------------------------- -- - ----=--- -------------- - Private ❑ Character of soil to a depth of 3 feet: Sand-] �rtilt❑ Clay ❑ Peat❑ Sandy Loam -❑ Clay Loam ❑ Hardpan ❑ Adobe.% Fill Material ------------ If yes, type ---------------------------- (Plot plan, showing size of lot, location of system in relation to wells, buildings, etc. must be placed on reverse side.) i NEW INSTALLATEON: (No septic tank or seepage pit permitted if-pdblic�sewer is available within 200 feet,) PACKAGE TREATMENT, { ] SEPTIC TANK'[ ] Size______________ _------------------------------- Liquid Depth -----------.____-____..._-- i ( Capacity ----- -:---;Type -------------------- Materidit No. Compartments i1. 4 Distance to nearest:`Well- _______________________________Foundation __.__-______________ Prop. Line __._________._...._.__ -Ai- LEACHING LINE [ ] No. of Lines ______________________ Length of each line_______________________ ---- Total Length ----------------•--..__---- 'D' Box .--#--- - - Type Filter Material --------------------Depth Filter Material --------------------•-----------. ..------ Distance to nearest. Well ------------------------ Foundation ------------------------ Property Line --------- -------------- SEEPAGE PIT [ ] Depth ------ _____r______ Diameter -------- Number ____________________________ Rock Filled Yes ❑ No i❑ Water Table Depth `3,�c.1� .__�=- ------Rock Size -------------------------------- Distance to nearest; Well ________________________________________Foundation -------------------- Prop. Line __________.....___..__ REPAIR ADDITION rev. Sanitation[Permit# -------------------------------------------- �Requirements)I D ate .--------•--_-•------------.-.---- SePtPecify --------------------- �� 1 _ ---- -------- ` -------------- Poss! Field (Specify Req ments) --------------•`-0 -------- ------------ ------------------------ ---------- - ------------3--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ------------------ ----------------- ------------------- - ------------------.----------------------------------------------------------------------------------------------------- -------------------- (Draw existing and require`d addition on reverse side) I hereby certify that I have prepared this application and that the work will be done k accordance with San Joaquin County Ordinances, State Laws, and Rules and. Regulations of the San Joaquin Local Health District. Home owner or licen- sed agents signature certifies the following: . � } "I certify that in the performance of the work for which this permit is issued, I shall not employ any person in such manner as to become subject to Workman's Compensation laws of California." Signed ------------- ------------- ---- --r------ _ Owner BY --- - ------- --- --------------------------- Title ------- - L '--------- (If oth an owner[ FOR DEPARTMENT USE ONLY APPLICATION ACCEPTED BY .--. __ DATE __ �/. -1----------------- BUILDING PERMIT ISSUED ----------->i---- --- = DATE - ADDITIONALCOMMENTS ------------ T----------------------------------------•-----------•---------------- ------------------------------------- -----------------_--------- ------ 1 ------- ------------------- ----------------------------------------- --- -P - - - y-- ------------------- `� �-- ---------------------- Fina! Inspection b ------------------------------------- - ------Date ---- - ----- -- --- --- - SAN JOAQUIN LOCAL HEALTH DISTRICT E. H. 9 1-'48 Rev. 5M